Related Experiment Video
Updated: Mar 29, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Carotid Artery Stenosis with Acute Ischemic Stroke: Stenting versus Angioplasty
Mark R Villwock1, David J Padalino1, Eric M Deshaies1
1Crouse Neuroscience Institute, Neurovascular and Stroke Center, Syracuse, NY, USA.
Insights
For acute ischemic stroke patients with carotid stenosis, angioplasty alone showed higher mortality and stroke risks than stenting. Stenting may be beneficial for severe stenosis and unstable plaques in urgent interventions.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Optimal treatment for acute ischemic stroke in patients with carotid artery stenosis remains unclear.
- Endovascular revascularization is an option when open surgery is not feasible.
- Carotid stenting carries risks due to thrombogenic potential.
Purpose of the Study:
- To compare outcomes of angioplasty alone versus stenting in endovascular revascularization for acute stroke.
- To evaluate mortality and iatrogenic stroke rates between the two endovascular approaches.
Main Methods:
- Analysis of the National Inpatient Sample (2003-2012) for non-elective endovascular revascularization in carotid artery stenosis patients.
- Exclusion of patients treated with mechanical thrombectomy or thrombolysis.
- Comparison of categorical variables using Chi-squared tests and binary logistic regression for mortality and iatrogenic stroke, controlling for confounders.
Main Results:
- A total of 6,333 admissions were analyzed; 89% received stenting.
- Angioplasty alone was associated with significantly higher mortality (9.0% vs. 3.8%) and iatrogenic stroke rates (3.9% vs. 1.9%) compared to stenting.
- Adjusted analysis indicated elevated odds of mortality (OR 1.953) and iatrogenic stroke (OR 1.451) with angioplasty alone.
Conclusions:
- Endovascular angioplasty alone was linked to an increased risk of mortality in patients with acute stroke and carotid stenosis.
- The findings may suggest selection bias or that stenting benefits patients with severe stenosis and unstable plaques.
- Angioplasty alone should be cautiously considered in future trials for this high-risk patient group requiring urgent intervention.
Background:
When a patient with carotid artery stenosis presents emergently with acute ischemic stroke, the optimum treatment plan is not clearly defined. If intervention is warranted, and open surgery is prohibitive, endovascular revascularization may be performed. The use of stents places the patient at additional risk due to their thrombogenic potential. The intent of this study was to compare outcomes following endovascular approaches (angioplasty alone vs. stent) in the setting of acute stroke.
Methods:
We extracted a population from the National Inpatient Sample (2012) and the Nationwide Inpatient Sample (2003-2011) composed of patients with carotid artery stenosis with infarction that were admitted nonelectively and received endovascular revascularization. Patients treated with mechanical thrombectomy or thrombolysis were excluded. Categorical variables were compared between treatment groups with Chi-squared tests. Binary logistic regression was performed to evaluate mortality and iatrogenic stroke while controlling for age, case severity, and comorbidity burden.
Results:
About 6,333 admissions met our criteria. A majority were treated via stenting (89%, n = 5,608). The angioplasty-alone group had significantly higher mortality (9.0% vs. 3.8%, p < 0.001) and iatrogenic stroke rate (3.9% vs. 1.9%, p < 0.001) than the stent group. The adjusted odds ratios of mortality and iatrogenic stroke for patients treated with angioplasty alone were 1.953 (p < 0.001) and 1.451 (p = 0.105), respectively, in comparison to patients treated with carotid stenting.
Conclusion:
Multivariate analysis found the risk of mortality to be elevated following angioplasty alone. This may represent selection bias, but it also may indicate that symptomatic patients with stroke suffer from severe stenosis and unstable plaques that would benefit from stent placement. These results would caution angioplasty alone as an arm of a future randomized trial involving this severely burdened patient population requiring urgent intervention.
More Related Videos
09:36A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
Published on: August 12, 2025
04:30A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:27Peripheral Artery Disease III: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care